147,380 members

Skip to content. | Skip to navigation


Doing the unthinkable


Blog headlines

  • UK’s National Health Service teams up with the Radio Society of Great Britain to improve health and wellbeing
    4 March 2021

    This week's blog is by Paul Devlin, Emergency Care Improvement Support Team (ECIST), NHS England and NHS Improvement.

  • Structuring a PCN Social Prescribing Service for the post COVID world
    25 February 2021

    This week we have a blog by Nick Sharples.

  • Community-Oriented Integrated Care
    18 February 2021

    The blog this week is a short extract from a paper considering an approach primary care networks could use to move towards community-oriented integrated care.

  • Strategy Unit releases opensource model for planning vaccine centre capacity
    11 February 2021

    This week's blog is from The Strategy Unit who are sharing an opensource model to help with vaccine centre capacity planning.

  • Time to talk day
    4 February 2021

    A small conversation about mental health has the power to make a big difference.

  • Supporting Staff: the emergence of ‘long-covid’
    28 January 2021

    As we are now well into a second, or is it now the third, wave of Covid-19 it is becoming apparent that Covid is something we have not experienced before and it has unique implications for staff management. It is not just the possibility that staff may become acutely ill with the virus, but that for some they may go on to develop persistent debilitating symptoms that will affect their ability to go back to work. This article looks at the implications of long-covid for HR and service managers when looking to support health care professionals (HCPs) return to work.

  • Link of the week: Clinically-Led workforce and Activity Redesign (CLEAR)
    21 January 2021

    This week we are sharing a link to the Clinically-Led workforce and Activity Redesign (CLEAR) site that is funded by Health Education England.

  • So much more than an extra pair of hands
    14 January 2021

    The introduction of the additional roles reimbursement scheme for primary care networks has started to grow capacity in general practice to address the unsustainably high workload that has put so much pressure on GPs.

  • Primary Care Networks – how did we get here?
    7 January 2021

    This week we are sharing a blog by PCC’s chairman David Colin-Thomé.

  • A year like no other
    17 December 2020

    On 5 July 1948 the NHS was born, over the last 72 years challenges and changes have been remarkable but the service has probably never been tested as much as in the last nine months. There have previously been numerous re-organisations, multiple changes to hospitals, mental health services and a shift from the family doctor towards more integrated primary care services delivered by a range of professionals. However, rapid transformation of services to embrace digital technologies, and a shift change to work differently has been forced upon all areas of the health service this year.

  • Guest blog: David Hotchin
    11 December 2020

    This week we have a guest blog that was submitted to us by David Hotchin, written by a retired friend....obviously, he's used a little poetic licence.

  • What now for commissioning?
    3 December 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What now for primary care
    4 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • Boosting your resilience
    30 October 2020

    The last year has been a difficult one, who would have imagined last Christmas that we would have been in lockdown, with the NHS seriously tested by a global pandemic. So much change has happened and the resilience of people working in and with health and care services has been seriously tested. Resilience is our ability to deal with, find strengths in and/or recover from difficult situations. Its sometimes referred to as “bounceabiliy” – but bouncing in what way?

  • Link of the week: National Cholesterol Month
    23 October 2020

    Every month or week of the year seems to be an awareness week, October has more than its fair share.

  • New redeployment service offers talent pool of motivated, work-ready individuals
    15 October 2020

    People 1st International have shared some of the work they are doing to support people displaced from industries due to the Covid-19 pandemic. There is an opportunity for health and care services to benefit from this workforce.

  • Link of the week
    9 October 2020

    Article published in the BMJ looking at the ability of the health service to quickly bounce back to pre-Covid levels of activity and considers if it is desirable.

Friday, 16 June 2017

Doing the unthinkable

Disappointed by the result of the election? Console yourself with the thought that none of the alternatives would have made much difference to the NHS. Regardless of election pledges, all parties face the same economic reality, which permits very little room for manoeuvre.

Even allowing for Mrs May’s remarkable post-election discovery that austerity was just a bad dream, financial pressure on the NHS will continue. It will endure for as long as we are unable to provide as much healthcare as people would like.

That pressure has been greater in the past decade or so than in the previous decade, and may be greater in the next few years than anything we’ve seen yet, but we’re fooling ourselves if we think it ever goes away. Even if we had a satisfactory definition of need, it is unimaginable that the NHS budget could keep up with it.

The central question is not “How much is enough?” but “How much are we willing to spend?”

In the recent history of the NHS, dominated by a government whose dislike of raising taxes makes it ambivalent about the public sector, the question we have continued to address is a different one, centred on efficiency: “How well do we use the resources we have?” And the answer, despite trusts’ magnificent efforts over the past 12 months, continues to be: “Not well enough.”

The Lansley reforms were an expression of the belief that optimal use of resources is a structural issue. It’s safe to say that this theory, like the numerous experiments in structural reform that went before it, can now be retired – and equally safe to assume that it won’t be.

Meanwhile the efficiency question continues to dominate discourse and policy.

Earlier this month, the HSJ published a story about the latest plan to exert financial control on the NHS. Assuming the story is true (and the HSJ has a good record of getting it right) there is to be a new “capped expenditure process” applied to 14 areas, forcing them to make the “difficult decisions” that will enable them to live within their means – even, according to NHS Improvement, if that means “thinking the unthinkable”.

The impact of the measures, says the HSJ, could be “closing wards and services, blocking choice of private providers, systematically extending waiting times, and stopping some treatments”.

The Office of Budget Responsibility recently published a forecast that the NHS budget will need to increase by £88bn a year by 2067. Dramatic as it sounds in a headline, this is a conservative estimate based on an annual increase in real terms of 2%, only half the 3.8% average annual increase since 1978/79. What’s more, the OBR forecast is predicated on an assumption that we will spend a bigger proportion of GDP on health than we do today.

In that scenario we should be able to keep things ticking over and prevent a serious decline. It may be enough to keep the NHS we have. For the NHS we want, start adding zeroes.

The government’s commitment to funding falls far short of the OBR forecast, of course. We’ve had our frontloaded settlement. Unless the picture changes dramatically, the next two years will be very tight indeed and after that, who knows?  

Long term we continue to hope for solutions involving self-care, healthier lifestyles, better technology, different models of care provision and medical breakthroughs. Some of these may generate the improvements in efficiency that governments and taxpayers long for, but it won’t happen the other way round. Privation does not often produce innovation.

To borrow the hated phrase that has come to dominate NHS commentary in recent years, efficiency is doing more for less – or at least doing more for the same money. But the narrative is shifting: we have begun to accept that what we really mean is doing less for less. 

Fine, as long as we’re clear about that. But let’s not pretend that the net effect on the nation’s wellbeing will be “cost-neutral” or engage in Jeremy Hunt style sophistry about the causal relationship between cost-reduction and quality.

While the regulators bear down on the health economies considered most profligate, demanding that they stick to their budgets, they continue to insist that no decisions should be taken that compromise patient safety. It doesn’t take a degree in philosophy or economics to see the problem with this position.

At best, the measures planned by NHS England and NHS Improvement are just the latest outburst from angry but ineffectual parents who want their kids to know they really mean it this time. At worst, they mark a continuation of a policy obsession with the balance sheet and its terrifying next phase: the transition from thinking the unthinkable to doing it. 

Editor: Julian Patterson


margaret ainger
margaret ainger says:
Jun 19, 2017 09:17 AM

Thing is. No one is prepared to support worse treatment for patients. So commissioners are "damned if they do and damned if they don't".